The influence of obesity on the complications and outcomes of shoulder arthroplasty: A systematic review and meta-analysis

OBJECTIVE: This systematic review aimed to determine whether obesity has a negative impact on the incidence of complications and functional scores of all types of shoulder arthroplasty. METHODS: Electronic databases such as PubMed, Embase, Web of Science, and Cochrane were systematically searched for publications concerning obesity and shoulder arthroplasty. The Newcastle–Ottawa scale criteria were used to evaluate the study’s quality. A total of 15 studies were identified involving total shoulder arthroplasty, reverse total shoulder arthroplasty, or hemiarthroplasty. The studies comparing the outcome of shoulder arthroplasty in different weight groups were conducted after the search of related literature and grouped according to different weights and compared with each other. Counted data used odds ratio value and its 95% CI for data analysis, and measurement data used weighted mean difference and its 95% CI for statistical analysis. RESULTS: The remaining 12 articles met the inclusion criteria and were included in this review. Any infection was reported in 6 studies, including 197 013 patients. Infections were more likely to occur in obese patients, with an odds ratio of 3.38 (95% CI, 2.28-5.02). The operation time of overweight patients (body mass index >25 kg/m(2)) was significantly longer than that of normal-weight patients (odds ratio, 6.90; 95% CI, 3.79-10.00). The venous thromboembolism was more likely to occur in obese patients (odds ratio, 3.39; 95% CI, 3.6-4.28). In addition, there was no significant difference in the dislocation rate and revision rate of prostheses among the groups. Patients who undergo shoulder arthroplasty could obtain a good American Shoulder and Elbow Surgeons score (Mean Difference [MD], 1.87; 95% CI, −2.08 to 5.82), regardless of their body mass index. CONCLUSION: Obesity had a negative impact on the prognosis of patients treated with shoulder arthroplasty. Additionally, obese patients require longer surgical times than normal-weight patients, although all patients can attain positive functional outcomes. Level of Evidence: Level III, Therapeutic Study.